Copyright © 2002 by the European Society of Cardiology.
Usefulness of the presenting electrocardiogram in predicting myocardial salvage with thrombolytic therapy in patients with a first acute myocardial infarction
a Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand
b Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
c Regional Medical Cardiology Centre, Heart Centre of Saratosa, Florida, U.S.A.
d Royal Victoria Hospital, Belfast, Northern Ireland
e Flinders Cardiovascular Centre, Adelaide, South Australia
accepted May 9, 2001
Abstract
Aims Patients with Q waves and T-wave inversion are generally at a later stage of the infarction process than patients without these changes. Our aim was to investigate whether a single assessment of electrocardiographic parameters at presentation would predict the proportion of myocardium salvageable by thrombolytic therapy.
Methods and Results Electrocardiographic algorithms to calculate the potential and final infarct size have been developed and allow the proportion of myocardium salvageable with therapy to be calculated. This was measured in 146 patients with acute myocardial infarction who had angiography at a median of 91min after streptokinase. The relationship between myocardial salvage and the electrocardiographic parameters at presentation (Q waves, T-wave inversion, quantitative ST segment changes, and the initial QRS score), was examined together with the 90-min angiographic parameters (TIMI flow grade and collateral grade), clinical parameters (haemodynamics and age), and time to therapy. Parameters that correlated with myocardial salvage included the initial QRS score (r=–0·56, P<0·0001), Q wave grade (r=–0·36, P<0·0001), number of leads with ST depression (r=0·28,P <0·001), maximum ST depression (r=0·27, P<0·01), T-inversion grade (r=–0·26, P<0·01), and TIMI flow grade at 90min (r=0·21,P <0·02). The time from symptom onset to thrombolytic therapy did not correlate with salvage (r=–0·09). On multivariate analysis, only the initial QRS score and T-inversion grade on the initial electrocardiogram were independent predictors of salvage (multivariate r using both variables combined=0·57,P <0·001).
Conclusions The QRS score and T-wave inversion grade on the presenting electrocardiogram provide important information in predicting myocardial salvage. These parameters may help triage patients to appropriate therapies.
Key Words: Myocardial salvage, QRS score. thrombolysis
f1 Correspondence: Professor Harvey D. White, DSc, Director of Coronary Care and Cardiovascular Research, Department of Cardiology, Green Lane Hospital, Private Bag 92189, Aukland 1030, New Zealand.
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